Please complete the following information about your household

* REQUIRED DATA (Please Note: In order to update or change a birthday, you must call the Parks and Recreation office)
User Name (up to 50 chars)
Password (up to 50 chars)
Retype to Confirm
Head of Household Information
Name of Primary Guardian (First)
Name of Primary Guardian (Last)
Gender
School Grade
or highest grade
completed highest grade completed
Secondary Guardian Information
Name of Secondary Guardian (First)
Name of Primary Guardian (Last)
Gender
Date of Birth (mm/dd/yyyy)
School Grade
or highest grade
completed highest grade completed
Email and Phone Information
Primary EMail Address
Re-Type to Confirm EMail Address
Alternate Email Address
Alternate Email Address
Alternate Email Address
Home Phone w/ area code (xxx)xxx-xxxx
Cell Phone w/ area code (xxx)xxx-xxxx
Work Phone w/ area code (xxx)xxx-xxxx
Work Extension
Address Information
Mailing Address
Street Address if different
City
State
Postal/Zip Code (5 digits only)
Country
Emergency Contact Information
Name of Emergency Contact (First) Name of Emergency Contact (Last) Contact Phone w/ area code Relationship

#1
Date of Birth (mm/dd/yyyy)
I would like to receive updates via e-mail (Please Note: If this is not checked, you WILL receive information specific to programs you have signed up for via e-mail; you WILL NOT received general information).

* REQUIRED DATA (Please Note: In order to update or change a birthday, you must call the Parks and Recreation office)